Eur J Pediatr. 2026 Jun 23;185(7):518. doi: 10.1007/s00431-026-07195-9.
ABSTRACT
Children with asthma commonly present with multiple allergic comorbidities; however, the quantitative dose-response relationship between cumulative allergic burden and lung function has not been established in pediatric populations. This retrospective cross-sectional study included 264 treatment-naive children with asthma aged 4-16 years. An allergy burden score (ABS) was constructed using a cumulative disease count strategy incorporating allergic rhinitis, atopic dermatitis, food allergy, drug allergy, and family history of allergic disease. Multivariable linear regression and restricted cubic spline (RCS) analyses assessed dose-response relationships between ABS and FEV1% predicted. Bootstrap-based statistical decomposition examined the contribution of type 2 inflammatory markers, and logistic regression assessed the odds of lung function abnormality. In the fully adjusted model, each 1-point increase in ABS was associated with a 3.03% decrease in FEV1% predicted (95% CI: – 3.77 to – 2.29; P < 0.001). RCS analysis indicated significant nonlinearity (P for nonlinearity < 0.001), with accelerated decrease at ABS ≥ 3. Type 2 inflammatory markers accounted for only 2.7% of the statistically decomposed total association. Each 1-point increase in ABS was associated with 43% higher odds of lung function abnormality (adjusted OR = 1.43, 95% CI: 1.07-1.94).
CONCLUSION: A dose-response association exists between cumulative allergic comorbidity burden and lung function impairment in treatment-naive children with asthma. Peripheral type 2 inflammatory markers explain only a small proportion of this association, suggesting additional contributing mechanisms. The ABS may warrant further evaluation as a simple clinical indicator for identifying children with greater lung function impairment, pending prospective multicenter validation.
TRIAL REGISTRATION: Not applicable. As a retrospective cross-sectional study, this research analyzed existing medical records without prospective assignment of interventions by the research team, and therefore does not meet the WHO criteria for clinical trial registration.
WHAT IS KNOWN: • Allergic comorbidities are prevalent in children with asthma and associated with worse clinical outcomes. The quantitative dose-response relationship between cumulative allergic burden and lung function has not been established in pediatric populations.
WHAT IS NEW: • Each 1-point increase in the Allergy Burden Score (ABS) was associated with a 3.03% decrease in FEV1% predicted, with a nonlinear threshold effect at ABS ≥ 3. Type 2 inflammatory markers collectively accounted for only 2.7% of the total association, suggesting that mechanisms beyond peripheral type 2 inflammation may be involved.
PMID:42337151 | DOI:10.1007/s00431-026-07195-9
